From a NYT Opinion Essay by two-time heart transplant recipient Amy Silverstein, who kept her second heart healthy but is dying of cancer in part due to her transplant medications.

Artificial Intelligence

Toku Envisions Retail-Based Retinal CVD and Diabetes Screening

Cardiovascular disease and diabetes screening might be headed to your neighborhood eyeglasses retailer, at least if retinal AI startup Toku Eyes and its heavyweight optical industry backers prove correct.

Toku Eyes just secured a $8M Series A round that it will use to accelerate the development of its unique AI-based retinal image analysis solution, which identifies patients with retinal biomarkers associated with higher risks of CV events, stroke, and diabetes during routine eye exams.

The funding round was co-led by two companies who are very capable of incorporating Toku Eyes into millions of routine vision exams:

• National Vision – The second largest U.S. optical retailer (>1,300 stores), which emphasized its plans to bring Toku’s AI screening to its patients, and to “bridge the gap” between eye care and primary care providers. 
• Topcon Healthcare – A leading eye care hardware and software company, which will provide Toku with data science support, and make Toku its first ever Entrepreneur in Residence.

Toku Eyes’ AI-based solution analyzes images from retinal cameras to detect changes in blood vessels and pigmentation, allowing early detection of CVD, diabetes, and diabetic retinopathy in people who might not be flagged through traditional medical care visits.

That proactive screening workflow might seem like a longshot to some CW readers or seem like a concerning source of incidental findings to others, but we’ve already witnessed enough retinal AI startups and studies to show that others see potential in this approach.

• Toku Eyes’ focus on existing eye care settings, technologies, technicians, and patient groups could also help it to avoid the access and economic challenges that have hindered other attempts at proactive CVD screening.

The Takeaway

Healthcare is littered with the bones of innovative disease screening approaches that haven’t found meaningful adoption, including many that were far more closely connected to the specialists dedicated to diagnosing and treating those same diseases. 

However, the continued challenges with early detection of CVD and diabetes suggests that we still need creative approaches to screening, and that could mean detecting some at-risk patients via their routine eye exams.

Personalized Cardiac Care Through Science-Based Plaque Analysis

Check out Cleerly’s latest Cardiac Beat video, where National Jewish Health’s cardiovascular prevention and wellness leader, Dr. Andrew Freeman, and Cleerly founder and CEO, Dr. James Min, discuss addressing the root cause of heart disease and personalizing care through science-based plaque analysis.

Reducing Variability in Echo Analysis

What if AI could produce echo measurements that are comparable to expert physicians, but with less variability? That’s precisely what this Nature study revealed about Us2.ai’s solution, finding that its measurements had fewer and smaller differences compared to three human experts than when the experts were compared with each other.

The First Step to Coronary Artery Disease Diagnosis

HeartFlow’s new RoadMap Analysis solution allows CT readers to accurately, efficiently, and consistently identify stenoses in the coronary arteries. See how RoadMap Analysis’ visual and quantitative insights into the narrowing of all major coronary arteries helps readers evaluate coronary CT angiograms before determining the need for an FFRCT.

The Wire

• CVD’s Cancer Risks: New research out of Stanford and MD Anderson showed that people with CVD have greater risks of developing cancer, potentially due to atherosclerosis’ relationship with certain cancer subtypes. Using claims data from 27M cancer-free individuals over a >36mo follow-up period, they found that people with CVD are 12% more likely to develop cancer, while atherosclerotic CVD has greater cancer risks than nonatherosclerotic CVD (20% vs. 11%). Atherosclerotic CVD was specifically associated with lung, bladder, liver, colon, and other hematologic cancers.

• Cardiology @ HIMSS23: Last week’s HIMSS 2023 conference welcomed ~35k healthcare IT professionals to the Windy City, and revealed new and strengthening HIT trends towards the cloud, generative AI, and the overall connection of care across departments and settings. Although far from a cardiology show, the HIMSS exhibit hall revealed efforts that should have a cardiology impact, including the continued evolution of virtual care and RPM solutions, enterprise imaging vendors’ growing focus on cardiology, and digital health companies’ efforts to enhance care coordination and communication.

• Graphene-Based Pacemaker: Scientists from Northwestern and the University of Texas developed a graphene-based cardiac implant that can sense and then treat irregular heartbeats with electrical stimulation. Graphene is a “super material” that’s exceptionally strong, lightweight, flexible, and conductive, allowing the implant to take the shape of a temporary tattoo, and rely on an external source of optical light to sense irregular heart rhythms and stimulate the heart.

• Boston Scientific Eying Shockwave: Interventional cardiology insiders have been buzzing since news emerged that Boston Scientific might acquire Shockwave Medical. The deal could be Boston Scientific’s biggest ever, helped by the fact that Shockwave’s market cap jumped 29% over the last year to $9.6B (and by ~14% following the takeover news). Shockwave’s unique approach for breaking up cardiovascular calcium using sonic pressure waves has made it one of very few interventional device companies to succeed while remaining independent, although that performance surely also makes it an attractive acquisition target.

• Marshall-Plan Ablation Strategy: Preliminary data from EHRA 2023 suggests that the Marshall-Plan, a three-step ablation strategy, may help eliminate arrhythmias in persistent AF patients. The novel strategy consists of 1) pulmonary vein isolation; 2) ethanol infusion of the vein of Marshall; and 3) a linear ablation designed to block the three main isthmuses to the pulmonary veins. The trial (n=120) compared the Marshall-Plan strategy to PVI alone. After a 10-month follow-up, the success rate in the Marshall-Plan group was significantly better than the PVI only group (87% vs. 70%). 

• BIOTRONIK’s DX ICD System Improves AF Monitoring: The MATRIX study found that BIOTRONIK’s DX single-lead implantable cardioverter-defibrillator (ICD) system, equipped with home monitoring technology, successfully detects subclinical AF. Among 1,841 patients, the ICD system’s positive predictive values for detecting true atrial arrhythmias were 95.1% for 6 min to <1-hour episodes, 99.6% for 1-hour to <24-hour episodes, and 100% for episodes lasting over 24 hours.

• Microsoft and Epic’s Generative AI Alliance: Microsoft and Epic announced an extension of their relationship with the goal of integrating generative AI tools like ChatGPT into EHRs. The companies hope to leverage the power of ChatGPT for tasks like drafting messages and bringing natural language queries and interactive data analysis to a “comprehensive array” of Epic solutions. Considering that providers often prioritize technologies that are easiest to integrate in their workflows, this might be the first way generative AI makes it into many healthcare settings.

• Caristo Adds CCTA AI Funding: CCTA AI startup Caristo Diagnostics completed a $16.3M Series A round to support the commercialization of its CaRi-Heart technology, including its expansion in the UK and EU and its entry into the U.S. Caristo is among a handful of venture-backed CCTA AI startups (also: HeartFlow, Cleerly, Elucid, Artrya), but uniquely focuses on coronary inflammation burden to assess cardiac mortality risk, in addition to the presence of coronary plaques.

• 4D Flow MRI for Atrial Fibrillation: New research presented at last week’s ARRS 2023 meeting showed that cardiac MRI 4D Flow analysis could help assess the effectiveness of left atrial appendage occlusion (LAAO) procedures in AFib patients. The researchers used 4D Flow and 3D-printed LA phantoms to assess LA flow dynamic changes before and after percutaneous LAAO (a current clinical blindspot), revealing very different volumes and percentages of LA flow stasis in the correctly occluded (70.82 ml, 38.97%), incorrectly occluded (73.17 ml, 39.02%) and pre-procedural (79.11 ml, 39.71%) models.

• USHV Expands in Texas with HeartPlace: Cardiology managed service organization US Heart & Vascular put its private equity funding to use again, acquiring major Dallas-Fort Worth-based practice HeartPlace, the largest physician-owned cardiology group in North Texas (70 clinicians, ~29 locations). HeartPlace becomes the sixth Texas-based practice to join USHV, which has expanded across Tennessee, Arizona, Texas, and Kansas since forming in 2021, with the goal of creating a nationwide value-based care-focused cardiology practice.

• Remote Monitoring Socioeconomics: A cross-sectional study of 4,206 hospitals revealed that socioeconomic status (SES) impacts the adoption of remote patient monitoring (RPM) for chronic care management. Rural hospitals near lower-middle quartile SES households were 33.5% less likely to adopt RPM compared to those near the highest quartile SES households, while urban hospitals near the lowest quartile SES households were 41.9% less likely to adopt RPM.

Reducing ECG Background Noise

Monebo’s Kinitec Rhythms ECG Algorithm separates true ECG signals from background noise, leading to more accurate diagnoses and improved operator efficiency. See for yourself how the algorithm measured up to a gold standard.

Making the Leap to Outsource Post-Processing

Interested in how to outsource cardiac image post-processing, but not sure where to start? PIA walks you through how to assess and compare vendors, understand pricing models and payment options, and outline your requirements to identify vendors who meet your clinical needs. 

Start Measuring What Matters

Looking to optimize your cardiovascular imaging services, but don’t know what to measure? Check out this Change Healthcare report for insights on how to track and evaluate your cardiovascular imaging performance, assess quality, and enhance operational efficiency. Read the full article now and start measuring what matters!